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All Journal SAINS MEDIKA : JURNAL KEDOKTERAN DAN KESEHATAN Jurnal Profesi Medika: Jurnal Kedokteran dan Kesehatan Bioscientia Medicina : Journal of Biomedicine and Translational Research JOURNAL OF COMMUNITY MEDICINE AND PUBLIC HEALTH RESEARCH CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL INDONESIAN MIDWIFERY HEALTH AND SCIENCES JOURNAL Bioscientia Medicina : Journal of Biomedicine and Translational Research Caring : Jurnal Pengabdian Masyarakat MEDICINUS
Prihaningtyas, Rendi Aji
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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DIFFERENCES OF BIRTH WEIGHT AND ONSET OF ACHOLIC STOOL BETWEEN EXTRAHEPATIC AND INTRAHEPATIC CHOLESTASIS Setyoboedi, Bagus; Situmorang, Lasmauli; Prihaningtyas, Rendi Aji; Arief, Sjamsul
Indonesian Midwifery and Health Sciences Journal Vol. 8 No. 2 (2024): Indonesian Midwifery and Health Sciences Journal, April 2024
Publisher : UNIVERSITAS AIRLANGGA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/imhsj.v8i2.2024.93-101

Abstract

Background: Biliary atresia (extrahepatic cholestasis) and neonatal hepatitis (intrahepatic cholestasis) are two main causes of cholestasis. It is important to distinguish the type of cholestasis for determine management. Patient with intrahepatic cholestasis have birth weight lower than extrahepatic cholestasis. Onset of acholic stool in extrahepatic cholestasis usually appear in 15-30 days of first life. The aim of the study to identify differences of birth weight and onset of acholic stool between the type of cholestasis. Method: A retrospective study on cholestasis children aged under 2 years was conducted at Dr. Soetomo General Academic Hospital from January 2012 to December 2016. A thorough history of birth weight and onset of acholic stool were undertaken. Based on histopatology liver biopsy patients were classified into twogroups: I (extrahepatic cholestasis) and II (intrahepatic cholestasis). Result: Statistical analysis of Mann Whitney U was used with p<0.05 being significant. A total of 84 children were included, 55% were male. 40 children suffered from extrahepatic cholestasis (mean age 4.8 ± 2.6 months old) and 44 children suffered from intrahepatic cholestasis (mean age 2.9 ± SD 3.8 months old). The mean birth weight between extrahepatic and intrahepatic cholestasis were 2813 ± 704 gram vs 2717 ± 577 gram) (p=0.29). The mean onset of acholic stool between extrahepatic and intrahepatic cholestasis were 43.0 ± 60.6 days vs 26.6 ± 39.7 days (p=0.27). Conclusion : There is no difference of birth weight and onset of acholic stool between extrahepatic and intrahepatic cholestasis.
Collodion Baby And Cholestasis: A Rare Case Report Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Octariyandra, Syania Mega
Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan Vol 18 No 1 (2024): Jurnal Profesi Medika : Jurnal Kedokteran dan Kesehatan
Publisher : Fakultas Kedokteran UPN Veteran Jakarta Kerja Sama KNPT

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33533/jpm.v18i1.7392

Abstract

Collodion baby with cholestasis is an uncommon condition. The term "collodion baby" refers to newborns with thick skin covering their entire body. Neonatal cholestasis is a form of conjugated cholestasis hyperbilirubinemia caused by reduced bile flow. The condition causes persistent jaundice (over two weeks) and elevated conjugated bilirubin. Genetic abnormalities or gene mutations have been reported in neonatal ichthyosis syndrome with cholestasis. A case report of a collodion baby, a rare congenital condition characterized by a parchment-like membrane covering the entire body, was brought to Dr. Soetomo General Academic Hospital. Prolonged jaundice was one of the other findings. A skin biopsy found characteristics consistent with the diagnosis of collodion in a newborn. The paediatric team managed this case, which was treated in collaboration with a dermatologist. This case showed that newborn collodion syndrome required skin care, cholestasis screening, and jaundice management from birth.
Hepatocellular Carcinoma with Inferior Vena Cava Thrombus in a Child Pratiwi, Fauziah; Prihaningtyas, Rendi Aji; Setyoboedi, Bagus; Ontoseno, Teddy
Current Internal Medicine Research and Practice Surabaya Journal Vol. 5 No. 1 (2024): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v5i1.49091

Abstract

Hepatocellular carcinoma (HCC) in children is the second common malignant liver tumor after hepatoblastoma. Chronic hepatitis B virus (HBV) infection causes most hepatocellular cancer worldwide. Metastases to the inferior vena cava (IVC) and right atrium (RA) tumor thrombi are even less common. We reported a case of a 13-year-8-month-old girl with HCC and IVC involvement. Vascular invasion predicts poor overall survival in HCC patients. Patients with HCC involving the IVC had a higher risk of sudden mortality and a poor treatment outcome. It is difficult to treat, and no standard therapy has been established. This case report aimed to describe HCC with IVC involvement. This is a rare disease with a poor prognosis, therefore it is important to detect and manage early.
The Successful Administration of Steroid in Extrahepatic Cholestasis Winahyu, Anindya Kusuma; Prihaningtyas, Rendi Aji; Setyoboedi, Bagus; Arief, Sjamsul
Journal of Community Medicine and Public Health Research Vol. 4 No. 2 (2023): Journal Community Medicine and Public Health Research
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jcmphr.v4i2.47751

Abstract

Biliary atresia is the most common cause of liver transplantation in children. Kasai surgery is still a bridging therapy for biliary atresia, but patients are often late for treatment. Based on the currently proposed theory, biliary atresia results from a progressive inflammatory process and progresses to fibrosis of the bile ducts. A case of a 1.5-month-old boy with prolonged jaundice followed by acholic stools and dark urine was presented. He had cholestasis, elevated GGT levels, and a liver biopsy suggesting extrahepatic cholestasis. He was treated with methylprednisolone, ursodeoxycholic acid, and vitamin supplementation was started orally. After steroid therapy, direct bilirubin levels decreased rapidly to 0.55 mg/dl on day 14. Jaundice, acholic stools, cholestasis, and liver function tests were improved. Therapeutic opportunities based on the pathogenesis of inflammation in biliary atresia using steroids may provide new opportunities for non-surgical management of biliary atresia in the early phase of the disease.
Delayed Admission in Neonatal Cholestasis Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Winahyu, Anindya Kusuma; Arief, Sjamsul
Journal of Community Medicine and Public Health Research Vol. 5 No. 2 (2024): Journal Community Medicine and Public Health Research
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jcmphr.v5i2.47315

Abstract

Delayed diagnosis of cholestasis in neonates remains a problem. Cholestatic jaundice is a pathological condition that requires immediate treatment, such as biliary atresia. This study aims to analyze the characteristics of infants with cholestasis who seek treatment at a tertiary hospital. This study was a cross-sectional study to determine the characteristics of infants with cholestasis treated at the tertiary hospital at Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia. Subjects were collected using medical records using the consecutive method from 2019 to 2021. The inclusion criteria in this study were infants aged >2 weeks who suffered from cholestasis. The age of the 111 infants with cholestasis involved was 4.8 ± 2.9 months old. A total of 27 (24.3%) infants visited the hospital at the age of <2 months, 36 (32.4%) at the age of 2-4 months, but most of them, consisting of 48 (43.2%) infants, came to the hospital at the age of >4 months. Jaundice was present at birth in 23 infants (20.7%), and most infants had jaundice at 1 month of age in 75 infants (67.6%). Most of the infants (75 infants) had jaundice at the age of 1 month but visited the hospital at the age of >4 months. This showed that the late diagnosis of cholestasis in infants was still quite high. This study supports education for early detection of cholestasis in primary healthcare medical personnel, community health workers, and parents.
Socialization of stool color card for early detection of biliary atresia among healthcare professionals in Primary Healthcare facilities in Probolinggo Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Utomo, Martono Tri; Akbas, Ahmad Maulana Ifan; Octariyandra, Syania Mega; Arief, Sjamsul
Caring: Jurnal Pengabdian Masyarakat Vol 4, No 3 (2024): CARING Jurnal Pengabdian Masyarakat (Desember 2024)
Publisher : Caring: Jurnal Pengabdian Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.caringjpm.2024.004.03.4

Abstract

AbstractBackground: Biliary Atresia (BA) is an idiopathic progressive fibro obliterative disease affecting the extrahepatic biliary duct with clinical manifestations of biliary obstruction in the neonatal period. Infants with BA are characterized with acholic stools which are frequently unidentified due to daily variations in stool color. Early detection is essential to reduce morbidity and mortality rates in infants with BA. Objective: This project aimed to improve the knowledge of health workers in primary health facilities in Probolinggo about BA through socialization of stool color cards as an early detection tool. Methods: Socialization was conducted to midwives in primary health facilities in Probolinggo with pre-test and post-test methods. Results: A total of 35 midwives participated in this activity. The evaluation showed a significant increase in health workers' understanding of biliary atresia. The average pre-test score was 83.82 and increased to 92.18 in the post-test with a p-value=0.00, indicating the effectiveness of counseling in improving health workers' knowledge. In addition, the implementation of the stool color card as an early detection tool received a positive response from the participants, who stated that the tool is easy to use and helps in identifying infants at risk of biliary atresia more accurately. Conclusion: The level of knowledge of health workers in primary health facilities regarding BA is still varied. Socialization of stool color cards may improve the understanding of health workers to accelerate early detection of cholestasis and improve the prognosis of infants with BA.
Challenges in Managing Portal Hypertension and Fibrosis in a Case of Biliary Atresia Post-Kasai Procedure—Implications for Early Detection and Long-Term Care Jasin, Yayu Dwinita; Prihaningtyas, Rendi Aji; Octariyandra, Syania Mega; Setyoboedi, Bagus; Arief, Sjamsul
Current Internal Medicine Research and Practice Surabaya Journal Vol. 6 No. 1 (2025): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v6i1.54321

Abstract

Biliary atresia frequently causes portal hypertension, resulting in significant morbidity and mortality. Elevated portal pressure can be detected as early as during a Kasai procedure. Pediatric portal hypertension is the primary cause of various complications, including variceal hemorrhage, ascites, and extra-hepatic processes. This paper aims to draw attention to the complications and limitations of the Kasai procedure by presenting a case of portal hypertension and fibrosis in an 8-month-old male infant with biliary atresia who underwent the procedure at 3 months. The patient was never completely free of jaundice post-surgery. The jaundice worsened, and the pale-colored stool reappeared two months later. The abdomen was distended, accompanied by ascites, hepatomegaly, splenomegaly, and dilated veins. Edema was present on the lower extremities and the scrotum. The patient was diagnosed with biliary atresia and portal hypertension. Supportive therapy was recommended as a preparatory measure before a liver transplant. However, the parents declined the procedure due to financial constraints. This case suggests that the Kasai procedure may not always be effective. Despite the timely execution of the procedure, liver fibrosis may persist and be associated with portal hypertension. Most patients develop significant fibrosis that progresses to cirrhosis, requiring a liver transplant. To date, biliary atresia remains the primary indication for liver transplant in children, with no alternative medical treatment recognized. This case report highlights the progression of portal hypertension and liver fibrosis following the Kasai procedure for biliary atresia, emphasizing the challenges in early detection, complications management, and the exploration of alternative therapeutic strategies.   Highlights: 1. This study critically reviews the limitations and complications of the Kasai procedure in treating biliary atresia, with particular focus on portal hypertension issues, for which case reports are limited. 2. This study highlights the important need for accessible and effective long-term treatment alternatives by presenting a pediatric case where financial constraints prevented a liver transplant. 3. The data from this study are anticipated to contribute to the advancement of healthcare equity and pediatric liver disease management.
Successful treatment of umbilical granuloma in infants using topical application of common salt: a serial case report Prihaningtyas, Rendi Aji; Ardhanariswari, Zubaity; Rini, Muji Retnaning; Faizi, Muhammad
Sains Medika: Jurnal Kedokteran dan Kesehatan Vol 16, No 1 (2025): June 2025
Publisher : Faculty of Medicine, Universitas Islam Sultan Agung (UNISSULA), Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30659/sainsmed.v16i1.35793

Abstract

An umbilical granuloma is a small, granulation tissue-filled swelling at the base of the umbilicus, commonly occurring in newborns. Various treatment options are available, including the topical application of common salt; however, its availability varies across healthcare facilities, and the most effective method remains uncertain. This serial case report describes infants presenting with umbilical masses accompanied by discharge. Physical examination revealed a flesh-like, protruding mass from the umbilicus, associated with yellowish and reddish discharge and surrounding normal skin. The granuloma was resolved entirely through the topical application of common salt. Our findings suggest that common salt is an effective, simple, and inexpensive treatment for umbilical granuloma. With regular monitoring, this approach could serve as a viable alternative to more advanced therapies.
Steroid Therapy on Cholestasis: A Case Report Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief; Prihaningtyas, Rendi Aji
MEDICINUS Vol. 38 No. 11 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/mp7wkf03

Abstract

Introduction: Cholestasis is a pathological condition associated with immune-mediated processes that interfere with bile flow, thus requiring early diagnosis and prompt treatment to ensure optimal outcomes. The use of steroid therapy in the treatment of cholestasis has not been previously reported. Case: A 2-month and 9-day-old male infant presented with jaundice beginning at one week of age, followed by pale stools and tea-colored urine. Physical examination revealed jaundice, hepatomegaly, and splenomegaly. Laboratory investigations showed elevated liver enzymes: aspartate aminotransferase (AST) 292 U/l, alanine transaminase (ALT) 187 U/l, gamma-glutamyl transferase (GGT) 312.7 U/l, and alkaline phosphatase (ALP) 882 U/l), along with elevated bilirubin level (total bilirubin 7.9 mg/dl and direct bilirubin 6 mg/dl). Cytomegalovirus (CMV) IgG was reactive. A two-phase abdominal ultrasound examination revealed a preprandial gallbladder size of 0.65 x 0.33 x 1.91 cm, a postprandial size of 0.37 x 0.29 x 0.73 cm. Liver biopsy revealed chronic hepatitis and mild fibrosis (F1). The patient was treated with methylprednisolone, which was gradually tapered off. Following steroid therapy, liver enzyme and bilirubin levels normalized, gallbladder size increased, and stool color darkened. Posttreatment gallbladder size showed an increase (preprandial 3.05 x 0.96 x 0.72 cm, postprandial 2.45 x 0.72 x 0.82 cm). Conclusions: Steroids may improve bile flow and prevent further liver damage. Targeting immune mechanisms could represent a promising approach for future cholestasis treatments.
Successful Steroid Treatment of Extrahepatic Cholestasis: A Case Report Setyoboedi, Bagus; Prihaningtyas, Rendi Aji; Irawan, Muhammad; Octariyandra, Syania Mega; Arief, Sjamsul
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 4 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i4.963

Abstract

Background: Biliary atresia is the most common cause of cholestasis. However, not all healthcare facilities are capable of performing Kasai surgery and liver transplantation. The involvement of inflammatory processes in the bile ducts triggered by viral infections has been suggested in several theories of pathogenesis. This case report describes the successful steroid treatment of an infant with extrahepatic cholestasis. Case presentation: A girl aged 2 months and 20 days presented with complaints of jaundice since the age of 2 weeks, with no improvement and worsening of the jaundice, with the color of the stools becoming paler than before. The nutritional status is normal. The physical examination revealed icteric sclera, hepatomegaly, and splenomegaly. There was cholestasis (total bilirubin 7.30 mg/dL and direct bilirubin 5.75 mg/dL), as well as elevated levels of AST (249 U/L), ALT (251 U/L), GGT (995.7 U/L) and increased to 1529.6 U/L, CMV reactive IgG 28.9, and Rubella reactive IgG 6.90. A two-phase ultrasound of the abdomen showed a thickening of the gallbladder wall. A liver biopsy showed mild portal fibrosis (F1). Steroids at a dose of 2 mg/kg/day in combination with ursodeoxycholic acid were administered. At follow-up one month later, the jaundice had improved. Stools were yellow-brown, and liver function tests and bilirubin were normal. Conclusion: Adjunctive steroid therapy to suppress the inflammatory process in biliary obstruction may be beneficial in the early phase of the disease, especially in limited surgical and transplant settings.
Co-Authors Akbas, Ahmad Maulana Ifan Ardhanariswari, Zubaity Bagus Setyoboedi Irawan, Muhammad Jasin, Yayu Dwinita Martono Tri Utomo Muhammad Faizi, Muhammad Octariyandra, Syania Mega Pratiwi, Fauziah Rendi Aji Prihaningtyas Rini, Muji Retnaning Situmorang, Lasmauli Sjamsul Arief Sjamsul Arief, Sjamsul Syahbani, Primadita Teddy Ontoseno Winahyu, Anindya Kusuma